Provider Demographics
NPI:1174820013
Name:MISIURA, PAUL R (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:MISIURA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 LACKAWANNA AVE
Mailing Address - Street 2:
Mailing Address - City:OLYPHANT
Mailing Address - State:PA
Mailing Address - Zip Code:18447-1524
Mailing Address - Country:US
Mailing Address - Phone:570-489-5611
Mailing Address - Fax:570-489-3388
Practice Address - Street 1:418 LACKAWANNA AVE
Practice Address - Street 2:
Practice Address - City:OLYPHANT
Practice Address - State:PA
Practice Address - Zip Code:18447-1524
Practice Address - Country:US
Practice Address - Phone:570-489-5611
Practice Address - Fax:570-489-3388
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018291L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice